Treatment Burden in Older Adults with Diabetes and Multimorbidity

描述(由申请人提供)：美国老龄化人口中慢性病的日益流行给提供既以患者为中心又符合循证指南的医疗保健带来了巨大挑战。博伊德博士以前的工作表明，针对疾病的指南应用于患有多发病的老年患者受到推荐治疗方案和监测要求的复杂性、费用和负担的限制。对我们老龄化社会的最佳护理需要为医学上复杂的老年患者开发实用的循证治疗模式，允许根据患者的偏好和感知的治疗负担灵活地设定目标。因此，这个项目的总体目标是开发一种实用的工具，用于评估患有多发病的老年患者的治疗负担，以帮助医疗决策。为此，博伊德博士建议研究有糖尿病指数诊断的老年人，并结合其他共病情况，作为检验多发病患者治疗负担的模型。我们建议通过对指导护理项目(一项对患有多种疾病的老年人的研究)以及一系列焦点小组(目标2)的数据的二次分析，来表征这一人群中治疗负担的领域和调节因素。我们将综合这些数据和文献中的数据来开发一种临床实用的治疗负担衡量标准(目标3)，最后，我们将在临床环境中对该仪器进行试点测试(目标4)，作为R01研究的准备，以评估该仪器的临床效用，以改善患者的依从性和更广泛的多种发病率患者的结果。这项工作将为临床研究职业生涯提供基础，专注于改善患有多发病的老年人的决策和结果。博伊德博士的目标是成为一名独立的临床调查员，致力于改善对患有多发病的老年人的护理。博伊德博士与她的赞助商共同绘制了一条研究道路，这条道路是她之前工作的直接延伸，将在一个结构化的职业发展计划中进行，其中包括课程作业、指导和一个多学科研究咨询委员会。 相关性：许多老年人有多种并存的疾病，但还不知道如何最好地同时管理这些疾病。博伊德博士的目标是改善患有多发病的老年人的临床决策和结果。

DESCRIPTION (provided by applicant): The increasing prevalence of chronic disease in the aging U.S. population presents substantial challenges to delivering medical care that is both patient-centered and consistent with evidence-based guidelines. Dr. Boyd's prior work demonstrated that the application of disease-specific guidelines to older patients with multimorbidity is limited by the complexity, expense, and burden of the recommended therapeutic regimens and monitoring requirements. Optimal care for our aging society entails the development of practical evidence-based treatment models for medically-complex older patients that permit flexible goal-setting according to patient preferences and perceived treatment burden. The overall goal of this project is therefore to develop a practical tool for assessing treatment burden among older patients with multimorbidity, to assist in medical decision making. Toward this end, Dr. Boyd proposes to study older individuals with an index diagnosis of diabetes in combination with other comorbid conditions as a model for examining treatment burden in multimorbidity. We propose to characterize the domains and moderators of treatment burden in this population via a secondary analysis of data from the Guided Care project, a study of older adults with multi-morbidity (Aim 1), as well as through a series of focus groups (aim 2). We will synthesize these data and data from the literature to develop a clinically practical measure of treatment burden (Aim 3), and, finally, we will pilot test this instrument in a clinical setting (Aim 4), as preparation for an R01 study to evaluate the clinical utility of the instrument for improving patient adherence and outcomes for a broader population of patients with multi-morbidity. This work will provide the foundation for a clinical research career focused on improving decision making and outcomes for older people with multimorbidity. Dr. Boyd aims to become an independent clinical investigator dedicated to improving care for older people with multimorbidity. In concert with her sponsors, Dr. Boyd has charted a research path that is a direct extension of her prior work, and will be conducted within a structured career development plan that includes coursework, mentoring, and a multidisciplinary research advisory committee. RELEVANCE: Many older adults have multiple co-existing conditions, but it is not known how to best manage these conditions simultaneously. Dr. Boyd aims to improve clinical decision-making and outcomes for older people with multimorbidity.